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Liver cancer

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Treatments for primary liver cancer depend on the extent (stage) of the disease as well as your age, overall health, feelings and personal preferences. Discuss all of your options carefully with your treatment team. Choosing a treatment plan is a major decision, and it's important to take time to weigh your choices.

You may also want to seek a second opinion, especially with doctors experienced in treating liver cancer. A second opinion can provide additional information and help you feel more certain about the options you're considering.

The goal of any treatment is always to eliminate the cancer completely. When that isn't possible, the focus may be on preventing the tumor from growing or spreading. In some cases palliative care only is appropriate. Palliative care refers to treatment aimed not at removing or slowing the disease but at helping relieve symptoms and making you as comfortable as possible.

Treatments for primary liver cancer in adults
Standard therapies for adult liver cancer primarily include surgery, chemotherapy and radiation. Your doctor may also use other treatments — including alcohol injections, surgery to freeze the tumor (cryosurgery) or electric current therapy.

  • Surgery. The best treatment for localized resectable cancer is usually an operation known as surgical resection. In many cases the area of the liver where the cancer is found can be completely removed. Surgical resection may also be an option if you have localized unresectable cancer. You aren't a candidate for surgical removal of liver tumors if you have severe liver disease or only a small amount of healthy liver tissue.

  • Radiation therapy. This treatment uses high-dose X-rays to destroy cancer cells and shrink tumors. Radiation may come from a machine outside your body or from radiation-containing materials inserted into your liver. In an experimental technique, radiation is delivered to specific liver cells by attaching radioactive substances to antibodies — molecules produced by your immune system in response to invading organisms. Radiation may be used on its own to treat localized unresectable cancer. Or you may have radiation therapy following surgical removal of a tumor to help destroy any remaining malignant cells. Radiation can affect healthy tissue as well as tumors and may cause side effects such as tiredness, nausea and vomiting.

  • Chemotherapy. This treatment uses powerful drugs to kill cancer cells. Chemotherapy may be systemic — meaning it travels throughout your body in your bloodstream — or regional. In regional treatment, a small pump temporarily placed in your abdomen sends medications directly into the blood vessels leading to the tumor. You may have chemotherapy on its own or after an operation to help kill any remaining cancer cells. Systemic chemotherapy is generally not effective in treating liver cancer, but another type of chemotherapy — known as chemoembolization — is an important part of treatment for hepatocellular carcinoma. In this procedure, the hepatic artery — the major artery supplying blood to your liver — is blocked and chemotherapy drugs are injected between the blockage and the liver. Chemoembolization can improve survival rates in people with unresectable liver tumors. As with other forms of chemotherapy, chemoembolization can cause side effects such as abdominal pain, nausea and vomiting. In fact for many people, side effects from chemotherapy are the most disturbing aspect of cancer treatment. Side effects occur because chemotherapy damages healthy cells along with malignant ones. Fast-growing cells such as those in your digestive tract, bone marrow and bone are especially affected. But although side effects are common, their severity depends on the drugs used and your response to them. Sometimes you may have few reactions. On the other hand, you may experience symptoms such as nausea and vomiting, fatigue, infection and hair loss. It may help to know that a new class of antinausea medications can reduce the most severe intestinal symptoms. Acupuncture and relaxation techniques, such as guided imagery, meditation and deep breathing, also can help reduce nausea and vomiting. Ask your treatment team about the side effects of any treatment you're considering and the best ways to minimize those effects.

  • Alcohol injection. In this procedure, pure alcohol is injected directly into tumors, either through the skin or during an operation. Alcohol dries out the cells of the tumor and eventually the cells die. Each treatment consists of one injection, although you may need a series of injections for the best results. Alcohol injection is a simple and safe procedure that has been shown to improve survival in people with small hepatocellular tumors. It may also be used to help reduce symptoms in cases of metastatic liver cancer. Side effects are usually minor.

  • Radiofrequency ablation. In this procedure, electric current in the radio-frequency range is used to destroy malignant cells. Using an ultrasound or CT scan as a guide, your surgeon inserts several thin needles into small incisions in your abdomen. When the needles reach the tumor, they're heated with an electric current, destroying the malignant cells. Radiofrequency ablation is an option for people with small, nonresectable hepatocellular tumors and for some types of metastatic liver cancers. The procedure has relatively few side effects, and you can usually go home within two to three hours after being treated. Radiofrequency ablation is effective in about 65 percent of cases and is usually successful only with smaller tumors.

  • Cryosurgery (cryotherapy). This treatment uses extreme cold to destroy cancer cells. Traditionally used to treat early-stage skin cancers, cryosurgery may now be an option for people with inoperable primary and metastatic liver cancers. It may also be used in addition to surgery, chemotherapy or other standard treatments. During the procedure, your doctor places an instrument (cryoprobe) containing liquid nitrogen directly onto liver tumors. Liquid nitrogen has a temperature of minus 320 F. Ultrasound images are used to guide the cryoprobe and monitor the freezing of the cells. Cryosurgery is less invasive than regular surgery and requires only a small incision. As a result you're likely to heal more quickly and have fewer complications. Side effects — which tend to be less severe than those associated with surgery, chemotherapy or radiation — include damage to the bile ducts and major blood vessels, leading to bleeding or infection. But the major drawback of cryosurgery is uncertainty about its long-term effectiveness.

  • Liver transplantation. In this surgical procedure, a diseased liver is removed and replaced with a healthy, donated organ. Liver transplantation may be an option for some people with small, early-stage liver tumors and for certain people with bile duct tumors. In other cases, however, a transplant may not improve long-term outlook because the cancer may recur outside the new liver.

Treatments for primary liver cancer in children
Liver cancer in young people is rare. As a result most children with the disease are treated at centers that specialize in childhood cancers. In general, the treatments available for children are the same as for adults, and the best approach depends on the stage and type of cancer as well as the child's age and overall health.

Clinical trials
Because standard treatments often aren't effective in treating liver cancer, you may want to consider participating in a clinical trial — a research study that tries to improve current treatments or find new treatments for specific diseases. This can give you access to experimental therapies that might not otherwise be available. There are no guarantees with clinical trials, however, and you should fully understand the potential risks as well as possible benefits before undertaking this step.


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